首页|不明原因不孕女性降调节后中医证型分布与妊娠结局的关系

不明原因不孕女性降调节后中医证型分布与妊娠结局的关系

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目的:探讨接受体外受精-胚胎移植(IVF-ET)助孕的不明原因不孕患者使用促性腺激素释放激素激动剂(GnRH-a)进行垂体降调节后在促性腺激素(Gn)启动日的中医证型分布与临床妊娠结局的关系.方法:采用流行病学调查的方法,对2020年9月至2021年9月在西北妇女儿童医院生殖医学中心就诊的行IVF-ET长/超长方案的不明原因不孕女性在Gn启动日进行病史采集,对高频证候聚类分析,根据广义评估方程分析不同中医证型与胚胎实验室指标及临床妊娠结局的关系.结果:Gn启动日证型分布比例为肝郁气滞证36.29％(45例)＞肾阴亏虚证28.24％(35例)＞肾阳虚兼痰湿证21.77％(27例)＞血瘀证13.71％(17例).肾阳虚兼痰湿证患者的获卵率、卵裂率、正常受精率及临床妊娠率较其余证型显著降低(P＜0.05),移植日平均内膜厚度、A型内膜率、优质胚胎率、可利用胚胎率较其他证型偏低但差异无统计学意义(P＞0.05).结论:接受IVF-ET的不明原因不孕女性Gn启动日的中医证型以肝郁肾虚型最为常见,肾虚证型与胚胎实验室指标及临床妊娠结局具有一定相关性,施治应从肾入手改善指标提高妊娠率.
Tradition Chinese Medicine Syndromes in the Women with Unexplained Infertility after Pituitary Suppression:Distribution and Relationship with Pregnancy Outcomes
Objective:To explore the relationship between traditional Chinese medicine(TCM)syndrome distribution on the day of gonadotropin(Gn)initiation and pregnancy outcomes in the women undergoing in vitro fertilization-embryo transfer(IVF-ET)for unexplained infertility after pituitary suppression with gonadotropin-releasing hormone agonist(GnRH-a).Methods:An epidemio-logical survey was carried out to collect the information of medical histories on the day of Gn initiation in the women undergoing the long/ultra-long IVF-ET regimen for unexplained infertility in the Reproductive Medicine Center of Northwest Women's and Chil-dren's Hospital from September 2020 to September 2021.The cluster analysis was conducted for high-frequency syndromes.The generalized estimating equation was adopted to reveal the relationship of TCM syndromes with embryonic laboratory indicators and pregnancy outcomes.Results:The TCM syndromes on the day of Gn initiation followed a trend of liver depression and qi stagnation(45,36.29％)＞kidney yin deficiency(35,28.24％)＞kidney yang deficiency combined with phlegm and dampness(27,21.77％)＞blood stasis(17,13.71％).The patients with the syndrome of kidney yang deficiency combined with phlegm and dampness had lower oocyte retrieval rate,oocyte cleavage rate,normal fertilization rate,and clinical pregnancy rate than those with the other syndromes(P＜0.05).In addition,these patients presented slightly lower mean endometrium thickness,A-type endome-trium rate,high-quality embryo rate,and usable embryo rate than the patients with other syndromes on the day of transfer(P＞0.05).Conclusion:The most common TCM syndrome on the day of Gn initiation in the women undergoing IVF-ET for unexplained infertility was liver depression and kidney deficiency.The syndrome of kidney deficiency had correlations with embryonic laboratory parameters and clinical pregnancy outcomes,which indicated that the treatment should target the kidney to increase the pregnancy rate.

In vitro fertilization-embryo transferDay of gonadotropin(Gn)initiationUnexplained infertilityTCM syndrome dis-tributionKidney yang deficiencyFolliclesEndometrial receptivityClinical pregnancy rate

刘文君、李楠、张君蕾、邢晓苑、陈梅、白俊、吉娜、王海静

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陕西中医药大学,咸阳,712046

陕西中医药大学附属医院,咸阳,712046

体外受精-胚胎移植 促性腺激素启动日 不明原因不孕 中医证型分布 肾阳虚 卵泡 内膜容受性:临床妊娠率

国家自然科学基金青年科学基金项目重大疑难疾病中西医临床协作试点项目陕西省科技厅自然科学基础研究计划一般项目青年项目全国名老中医药专家传承工作室建设项目陕西省中医药管理局课题陕西中医药大学校级课题

81603656国医药办医政发[2018]3号2023-JC-QN-0899陕中医药函[2022]36号SZY-KJCYC-2023-0302023GP09

2024

10.3969/j.issn.1673-7202.2024.14.022

世界中医药
世界中医药学会联合会

世界中医药

CSTPCDCHSSCD北大核心
影响因子：1.266
ISSN：1673-7202
年,卷(期)：2024.19(14)
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